Her plea to pediatricians: Make sure that you, all of your staff, and your patients have been immunized against pertussis. Not only was the Society meeting during National Infant Immunization Week, but Washington State had just recorded its 1,000th case of pertussis in 2012, with 61% of cases in school-age children, she reported.

“It’s the worst we’ve seen in six decades,” Dr. Hayes said. “If infections continue at this rate, we’ll have more than 3,000 cases by the end of the year.”

Washington State had 1,008 reported cases of pertussis by April 21, 2012 – nearly 10 times more than the 110 cases reported during the same period in 2011, according to the U.S. Centers for Disease Control and Prevention. There are more pertussis cases in the state already for 2012 than there were in all of 2011 (965 cases) or all of 2010 (608 cases).

The Washington epidemic follows on the heals of a 2010 outbreak of 9,143 cases in California – the most in 63 years – that killed at least 10 infants.

My colleagues at IMNG Medical Media have been following the story, with multiple reports. The California epidemic probably was due to the waning immunity of the tetanus-diphtheria-acellular pertussis (Tdap) vaccine. Tdap vaccine is recommended for all health care workers.

When Dr. Michael E. Pichichero randomly asked 10 pediatricians if they’d had the Tdap vaccine, 8 of them said no, with some pretty weak excuses, if you ask me.

“I know that there are people in this room who have not had their Tdaps,” Dr. Hayes said with an accusing smile. “I also know that in busy practices, you have people in and out every day that have not had their Tdap. I’m calling on you to really get on it.” Make sure that your emergency rooms have Tdap in stock, too, she added.

“And if you’re not in Washington, don’t be smug about this, because you could be next,” Dr. Hayes said. Her public health colleagues in Oregon State are taking this so seriously that they’re planning to open pertussis booster clinics, she noted.

In case you missed it, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was a guest on the March 29, 2011 episode of Comedy Central’s “The Colbert Report.”

Early in the interview host Stephen Colbert asked Dr. Fauci to forecast the next “hot, newest” infectious disease. “I want to get my graphics department working on the next thing that’s going to scare the poop out of these people,” Mr. Colbert said, as the studio audience chuckled in the background. “Turkey herpes? What’s it gonna be?”

Then the discussion turned serious, with Mr. Colbert suggesting that the public attention on AIDS treatment and prevention has waned in recent years. He asked Dr. Fauci: “Why aren’t we talking about it if it’s no big deal?”

Dr. Fauci said that AIDS remains a “serious problem” in the United States, with 56,000 newly diagnosed cases each year. “It’s been that way for the last 10 or 15 years,” he said.

“Why are so many people getting it? Because we have abstinence education…” Mr. Colbert asked.

“That rarely works,” Dr. Fauci said, noting that the majority of Americans practicing high risk behavior lack access to AIDS education campaigns and to good health care. In 2010, he added, about half of new AIDS infections in the United States were among African Americans.

It’s hard to avoid hearing about hand washing at infectious disease meetings, and this was no exception.

image courtesy Flickr user Kleiner Kolibri

First came the observation from a senior surgeon that he finds many of his colleagues not washing their hands as regularly and conscientiously as they should, seemingly lulled by an inappropriate reliance on alcohol gels.

“Surgeons take a gob of alcohol-based hand scrub, put it on their hands and come into the operating room,” said Dr. Kamal M.F. Itani, chief of surgery at the VA Boston Healthcare System in West Roxbury, Mass. “They forget that the recommendation is to wash their hands and clean under their nails and then apply the alcohol agent. We need to rededicate ourselves to the proper use of these products.”

His observation on how surgeons and other health care workers often behave, and his emphasis that plain old soap and water trumps alcohol gel, strikingly echoed a similar message from another infectious diseases expert that I blogged about here 1 year ago.

The second message about hand washing by medical personnel came from an analysis of a hand-hygiene program run at Boston University Medical Center. The program came into being because hand washing among health-care personnel is notoriously poor, especially among physicians, said surgeon Dr. Dorothy W. Bird.

At the start of 2007, a hospital task force began a 2.5 year campaign to promote hand hygiene, including staff education and reminders and monitoring of compliance by measuring the amount of soap the staff used. By early 2009, the task force declared mission accomplished, with hand-washing volume exceeding the target rate and infection rates in the surgical intensive care unit significantly down. But the new analysis looked at what happened next, and it wasn’t good. With the program stopped, the reminders missing, and no one keeping tabs on the hand-washing rate, the surgical staff quickly reverted to its old ways and within a matter of months infection rates jumped back up significantly above the nadir reached at the end of the discontinued program.

The clear message: Hospital staff need ongoing reminders and monitoring to ensure their hands get washed. And the Boston University surgeons are restarting the education and monitoring program.

But some experts had been urging the move long before last year. Dr. Gregory Poland of the Mayo Clinic had been particularly outspoken, often delivering impassioned pleas to his fellow ACIP members to end the “creeping incrementalism” of adding new risk groups to the list one by one. He urged the committee instead to simply recommend flu vaccine for all. In a 2006 point/counterpoint in our primary care publications with current ACIP chair Dr. Carol Baker of Baylor College of Medicine, Dr. Poland said he believed the time was right; she didn’t.

At that time, many experts agreed with Dr. Baker. They supported the universal immunization concept in principle, but said more evidence was needed to justify it and better infrastructure was required to make it feasible.

Dr. Carol Baker

At the February ACIP meeting, I asked Dr. Baker what had changed. Her answer: “What we’ve learned is that infrastructure is built after ACIP makes a recommendation. Otherwise, there’s a year to say, ‘Well, we have a year before we have to think about this.'” But she noted that the 2009 pandemic did help expand the use of alternative venues for vaccine delivery, such as schools and retail stores.

Dr. Dale Morse, an ACIP member from 2005-2009 and chair the latter 2 years, said a lack of scientific data and the vaccine shortages of 2004-2005 were among the reasons he had voted against one of Dr. Poland’s motions for universal immunization about 4 years ago. “That was the wrong day, the wrong place, the wrong time,” said Dr. Morse.

Today, the science is more complete regarding the impact of influenza immunization. And, two new risk categories that emerged with pandemic H1N1 — 19-24-year-olds and obesity — are now covered by the universal recommendation.

Dr. Dale Morse, photo by Parker Smith/Elsevier Global Medical News

As Dr. Morse told ACIP, “While we still haven’t reached the levels of immunization that we’d like, we have an opportunity to build on the momentum gained over the past year. If we can’t make a universal recommendation now, when can we? From my perspective, today it’s the right place, the right day, and the right time.”

The influenza virus continues to lay low any infectious disease experts who claim to truly understand it, as two articles and an editorial in JAMA recently showed.

One report from the CDC found that influenza A (H1N1) resistance to oseltamivir, one of the main drugs used to treat the virus, has zoomed from being uncommon in the 2006-2007 flu season, to 12% of cases being resistant in 2007-2008, to 98% being resistant among cases so far in this 2008-2009 flu season.

Experts used to think that the mutation that causes the virus to become resistant to oseltamivir made it less likely to cause illness or death. No such luck. The CDC report and another study from the Netherlands found that it maintains its virulence.

An even bigger shocker: Both studies also found that the influenza virus developed resistance irrespective of how much oseltamivir was used. The paradigm of antibiotic overuse leading to bacterial resistance doesn’t seem to apply to influenza virus and its treatments. “That, frankly, has caught us with our intellectual pants down. That really did surprise us,” said Dr. William Shaffner of Vanderbilt University, Nashville, who was not part of these studies.

A fourth article about influenza in the same issue contained a little ray of sunshine, however. Vaccination reduced the risk of getting the flu, even in healthy, fit, members of the U.S. military. With fewer effective treatments due to resistance, getting an annual flu shot makes more sense than ever. So next flu season, roll up your sleeve…